Great post on Teens Who Self-Harm by Marie Hartwell-Walker, Ed.D. over at Psych Central.

In the blog Marie Hartwell-Walker encourages that “Self-harmers need to be understood, not scolded. They need to unlearn the idea that their feelings are “wrong” and learn that it’s okay to feel them. Most important, they need to learn new ways to manage stress and emotions that they find overwhelming.”

Also we just linked up with Dr. Mary Kay Nixon and her team of the Interdisciplinary National Self-Injury in Youth Network Canada (INSYNC). Lots of great info for youth, families and professionals.

For some interesting and powerful reading on self-harm I recommend the books Cut by Patricia Mccormick and Skin Game: A Memoir by Caroline Kettlewell

Dr. Perri Klass writes eloquently about boys and girls and sex, and the importance of values, manners and gender equality.  As a child and youth psychiatrist I find much of what she recounts not only reasonable but reasoned.  There is however a developmental neurobiological reality that can help us put these sex and youth issues into a wider perspective.  Simply put, neurodevelopment prior to puberty has as its major goal the survival of the individual to the time of puberty so that species reproduction can take place.  As a result, the adolescent brain normatively develops its drive for sex and the associated dopamine driven nigro-striatal-cortical systems associated with craving (yes – the same system that allows for addictions to begin).  So there we have the phylogeny of the species.  So what now?

Every society develops social structures that serve to channel and direct sexual activities in youth.  And, because the brains of young people can be modified by the environment that they are in, by and large these social structures do modulate these behaviors, although sub-group and sub-cultural frameworks may not always conform to wider social norms and expectations.

So to be simple about it – young people will generally channel their sexual expressions within social expectations created by their environments.  Environment can be helpful or un-helpful in this regard.  However, while we may not be able to control the relentless process of pre-programmed neurodevelopment, we can provide behaviorally optimizing and socially enhancing environments for young people.  These begin within the family and include all aspects of values and behavioral expectations.  They extend outside the family and are taken up by our institutions and collective organizations.  They should extend to the media and the advertising industry.  The most interesting question for me is why they do not seem to.

~ Dr. Stan Kutcher

you can read the original New York Times article here.

Teenagers are known for risk-taking, novelty seeking, reckless behaviour and impulsivity.

Risk-taking behaviour can take on many different forms, including the misuse of alcohol or drugs, engaging in unprotected sexual activity, some types of criminal activity or risky, adrenaline-producing sports like skydiving or motocross. While you may not have done all of these things, the majority of adolescents and young adults report participating in one or more risk-taking behaviours.

One reason for this is that the teenage brain is less able than the adult brain to inhibit impulsive behaviours. Adolescents become more able to control their behaviour as their brains mature, but efficient control of impulsive acts is not fully developed until adulthood. When teenagers are faced with a reward, the “reward” systems of their brains are disproportionately active compared to the “control” systems (which are later to mature). This makes it difficult for teenagers to be in command of their reward response, and makes them biased towards immediate gain over long-term gain.

A recent article on medicalnewstoday.com highlighted this shortsightedness of youth

According to popular stereotype, young teenagers are shortsighted, leaving them prone to poor judgment and risky decision-making when it comes to issues like taking drugs and having sex. Now a new study confirms that teens 16 and younger do think about the future less than adults, but explains that the reasons may have less to do with impulsivity and more to do with a desire to do something exciting.

Compared with adults, the researchers found, teenagers consider the future less and prefer immediate rewards over delayed ones (for example, $700 today versus $1,000 a year from now). But it may not be impulsivity that guides their lack of forethought. Instead, the study found that teens are shortsighted more due to immaturity in the brain systems that govern sensation seeking than to immaturity in the brain systems responsible for self-control.

While the origins of risk-taking behaviour in adolescents have been debated for a centuries and many explanations ranging from hormones to social pressures have been endorsed. But the truth is we are still not completely sure why adolescents and young adults are more prone to risk-taking behaviours.

We do however know that part of the answer lies in the way that brain development occurs during this part of the life-span and that risk-taking behaviors often decrease as the young person matures into adulthood. It’s the complex interplay amongst brain development, personality characteristics and the environment that lead to differences in risk-taking behavior amongst young people.

Interestingly, recent research suggests that the perception of risk does not vary greatly with age, but rather within the type of decision-making information that adolescents and adults use. So even though adolescents may be more prone to engage in risky behaviour, they are not irrational, unaware, or believe they are more invulnerable than adults. These findings suggest that young people certainly have the frontal lobe capabilities to self modulate risky behaviors – provided they understand how to do so.

(Great article from UC Davis Magazine about “What parents should tell college students about risky behavior . . . even if they don’t listen.”)

~ Dr. Stan Kutcher

Learning to drive is an important rite of passage for many teenagers. Getting a driver’s license often means more independence and mobility, but driving is also a big responsibility. The skill to safely drive a motor vehicle requires an ability to make flexible judgments and maintain an emotional balance in sometimes boring and often highly-stressful, unpredictable environments. For young people with Attention Deficit Hyperactivity Disorder this can be challenging.

Attention Deficit Disorder results from problems in functioning in one or more brain regions associated with the development and control of attention, motor behavior and impulsivity. Recent research has shown that the brains of young people with ADHD develop in the same manner that the brains of young people who do not have ADHD develop – just slower (on average about three years slower).

For young people learning to drive, slower brain development may have a significant impact. While lack of experience affects all young drivers, young people with ADHD are particularly vulnerable to the complex cognitive and emotional demands required to safely drive a motor vehicle.

Motor vehicle crashes are the leading cause of death in adolescents, and ADHD is a major contributor. Young drivers with ADHD are:

• 2 times more likely to have traffic collisions
• 3 times as likely to have injuries
• 4 times as likely to be at fault
• 6–8 ´ more likely to have license suspended

Other recent research has shown that young people treated with medications to help with their ADHD symptoms show substantially increased pathways between brain regions, thus allowing those regions to communicate faster and more effectively.

Right now we have a good idea of the different parts of the brain involved in ADHD, how these parts grow and develop, and what treatments are helpful for ADHD. Effective treatment of ADHD is likely to decrease the risk of driving misadventure of teens.

Check out this video on ADHD and Driving by Dr. Kenny Handelman on www.adhd.tv

~ Dr. Stan Kutcher & Dr. Laurence Jerome

Holidays for teens usually mean one thing … lots and lots of SLEEP!! But why the heck are teens so tired all the time?

One of the most significant changes linked to brain development that occurs during the teenage years, is related to sleep pattern alterations. Sleep patterns change during adolescence because the brain’s circadian system (biological clock) changes.

This change occurs as a result of a complex dynamic interaction between genetically determined brain development and the impact of the environment on that development. During the teen years the usual childhood pattern of get up early and go to bed early (the so called “lark” pattern) changes to a go to bed late and get up late (the so called “owl”) pattern. This natural change in circadian rhythm is accentuated by the teenager’s environment. Teens are often awash in bright lights late at night, electronic and social stimulation that keep them active into the wee hours, and weekend gatherings that push well into early morning. These factors all converge to set a new go-to-sleep-late and wake-up-late cycle.

Because teenagers stay up much later than younger children do, yet are still forced to wake up early on school days, their total sleep time is shorter (sometimes much shorter) on school days than on weekends, and this disrupts the rhythm of sleep. Teens need about 9 to 9 ½ hours of sleep every night, more than pre-teens need. But because they don’t get anywhere near this amount during the week, many teenagers try to catch up on lost sleep by sleeping in on weekends, which typically annoys their parents. It is important to remember that teenagers do not sleep late on weekends because they are lazy or antisocial, but because they are sleep deprived. They have created a huge sleep debt during the week and are paying it off on the weekend.

During the week many teens are actually sleep deprived. But what does that mean? Sleep deprivation in adolescents can negatively affect the control of behavior, emotion and attention, and is a significant impediment to learning, attainment of social competence and quality of life. Not getting enough sleep can also affect a teenager’s performance in school and other activities that require concentration and focus. Because school schedules are not based on the sleep/wake patterns of teenagers, many students in early morning classes report being less alert, more weary, and having to expend greater effort to pay attention. Reaction times and performance of adolescents are much better in the afternoon than in the morning. With all this sleep deprivation no wonder teens are late for class, sleepy at school, reluctant to be involved in extracurricular activities and cranky. And no wonder many parents find their teenagers to be a royal pain in the mornings!

Decreasing the amount of stimulating activities late at night (TV, phone, internet) is one way to recover lost sleep hours. Unfortunately, many of the social developments that might help correct the problem of adolescent sleep deprivation involve big social policy changes. These include restructuring school curriculums and policy, such as starting school later and ending school later (some school districts have tried this), and creating a broader awareness of the sleep deprivation problem among parents, teachers and physicians.

~ Dr. Stan Kutcher